International Journal of Medicine and Medical Sciences Vol. 5(2), pp.

55-59, February 2013

Available online at http://www.academicjournals.org/IJMMS
DOI: 10.5897/IJMMS12.107
ISSN 2006-9723 ©2013 Academic Journals

Full Length Research Paper

Importance of diet on disease prevention

Francesco Sofi1,2,3, Rosanna Abbate1, Gian Franco Gensini1,3 and Alessandro Casini1,2
1
Department of Clinical and Experimental Medicine, University of Florence, Italy
2
Agency of Nutrition, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
3
Don Carlo Gnocchi Foundation Italy, Onlus IRCCS, Florence, Italy.
Accepted 21 November, 2012

Over the last decades, a considerable body of evidence supported the hypothesis that diet and dietary
factors play a relevant role in the occurrence of diseases. To date, all the major scientific associations
as well as the World Health Organization, scientific and non-scientific organizations place an ever-
increasing emphasis on the role of diet in the strategies able to prevent noncommunicable diseases.
Many studies have evaluated the associations between food groups, foods, or nutrients and chronic
diseases, and a consensus about the role of nutritional factors in the etiology of noncommunicable
diseases such as cardiovascular and neoplastic diseases has gradually emerged. Indeed, data from
analytical and experimental studies indicated a relation between increased consumption of some food
categories such as fruits and vegetables, fiber and whole grains, fish and moderate consumption of
alcohol and reduced risk of major chronic degenerative diseases, whereas increased total caloric
intake, body weight, meat and fats are associated with greater risk. However, the appropriate dietary
strategy to prevent chronic degenerative diseases remains a challenging and a highly relevant issue.
Recently, Mediterranean diet has been extensively reported to be associated with a favorable health
outcome and a better quality of life.

Key words: Diet, nutrition, diseases, health.

INTRODUCTION

During the past decades, a rapid expansion in the
number of relevant scientific fields, and in particular, the
amount of population-based epidemiological evidence
has clearly demonstrated the role of diet in preventing
and controlling morbidity and premature mortality result-
ing from non-communicable diseases (NCDs) (World
Health Organization Study Group, 2003).
The burden of NCDs is rapidly increasing worldwide. It
has been calculated that, in 2001, chronic diseases
contributed approximately 60% of the 56.5 million total
reported deaths in the world and approximately 46% of
the global burden of disease. Moreover, the proportion of
the burden of NCDs is expected to increase to 57% by
*Corresponding author. E-mail: francescosofi@gmail.com. Tel:
+39-055-7949420. Fax: +39-055-7949418.
2020 (World Health Organization, 2005). Almost half of
the total chronic disease deaths are attributable to
cardiovascular diseases; obesity and diabetes are
showing worrying trends, whereas neoplastic diseases
are still one of the commonest causes of mortality and
morbidity in Western countries, as well as neurodegene-
rative diseases which showed in the last years an
increasing trend of incidence. Moreover, the chronic
disease problem is far from being limited to the
developed regions of the world.
Contrary to widely held beliefs, developing countries
are increasingly suffering from high levels of public health
problems related to chronic diseases (World Health
Organization, 2005). The World Health Organization
(WHO) in its recent documents places a great emphasis
on the prevention of NCDs (World Health Organization
Study Group, 2003; World Health Organization, 2005,
2006). The most important risk factors for NCDs include
56 Int. J. Med. Med. Sci.
high blood pressure, high concentrations of cholesterol in
the blood, inadequate intake of fruit and vegetables,
overweight or obesity, stress, physical inactivity and
tobacco use. Five of these risk factors are closely related
to diet. Indeed, unhealthy diet is among the leading
causes of NCDs, including cardiovascular diseases, type
2 diabetes and certain types of cancer, and contribute
substantially to the global burden of disease, death and
disability.
Currently, the relationship between diet and diseases
has been studied intensively for nearly a century. The
first evidence of a possible relationship between dietary
habits and occurrence of diseases dates back to the
years following the World War II, when significant
variations in the incidence of major NCDs such as cardio-
vascular diseases and certain cancers were observed in
studies conducted in migrants that moved from countries
with a favourable dietary profile to a country with an
unfavourable and industrialized profile. Subsequently,
many studies investigated the influence of diet and
nutrition on the pathogenesis of the disease states
through using analytical, ecologic and epidemiological
approaches (Sofi et al., 2008).
To date, diet and nutrition are important factors in the
promotion and maintenance of good health throughout
the entire life course, and their role as determinants of
chronic degenerative diseases is well established, thus
occupying a prominent position in prevention activities.
DIET AND CARDIOVASCULAR DISEASES
Cardiovascular diseases are the first cause of mortality
and morbidity in Western countries (World Health
Organization, 2006). During the last decades, clinical
investigation on the prevention of cardiovascular
diseases has defined in an unquestionable manner, the
role of diet as a modifiable risk factor. Currently, it has
been largely demonstrated from epidemiologic studies
that increased consumption of fruits, vegetables, non-
refined cereals, and fish can reduce cardiac events and
related mortality in the whole population (World Health
Organization, 2005). The recent result from the
“InterHeart” study, a large case-control study that
investigated risk factors for myocardial infarction within
52 countries including non-developed, developing and
industrialized countries, demonstrated that diet is one of
the most important risk factors for the occurrence of
myocardial infarction, independently from all the other
parameters. In fact, consumption of fruit and vegetables
has been reported to be responsible for a significant and
relevant protection against the occurrence of myocardial
infarction in all the countries (Yusuf et al., 2004).
Furthermore, the significant interrelationships between
some of the most important risk factors such as diabetes,
hypertension, and dyslipidemia and dietary habits gave
further evidence towards the role of nutrition in preventing
cardiovascular diseases.
The preliminary scientific evidence about the role of
nutrition in the pathogenesis of cardiovascular diseases
has been supplied by the “Seven Countries’ Study”, an
epidemiologic study designed by Ancel Keys, the pioneer
of nutritional studies, at the beginning of the 1950s (Keys
et al., 1986). This study enrolled nearly 13,000 male
subjects of age ranging from 40 to 59 years, living in 7
different countries (Italy, Greece, the Netherlands, United
States, Finland, Japan, former Yugoslavia), with the aim
of evaluating the possible association between diet and
lifestyle habits and mortality and incidence of cardio-
vascular and neoplastic diseases. Since the first results
of the study, it became evident that there was a
significant difference in terms of incidence of diseases, as
well as of mortality among the cohorts of the study. At the
end of the 25 years follow-up, about one half of these
death cases were due to a coronary disease with
mortality rates remarkably differing in the various study
countries (Menotti et al., 1993).
In particular, a lower mortality rate for coronary heart
disease was recorded in Greece and in the South of Italy,
with 25 death cases every 1,000 inhabitants in a 25-year
period, whereas the highest mortality rate was recorded
in Finland with 268 death cases every 1,000 inhabitants
in a 25-year period. The low rate of cardiovascular
diseases in the Mediterranean regions of Europe
stimulated an increasing interest for the potential role of
their traditional diet in the protection from these diseases.
From that time onward, several studies have been
conducted in different study populations with the aim of
identifying the real relationship between nutrients, foods,
food groups and diseases, by showing that a dietary
profile typical of the Mediterranean regions is associated
with a reduced incidence of NCDs, as well as with a
reduced rate of mortality and morbidity (Sofi et al., 2008).
In the Mediterranean diet, olive oil rich in monoun-
saturated fatty acids is the prevalent visible fat, the intake
of saturated fat is relatively low, while fish guarantees a
substantial provision of polyunsaturated fats (n-3
polyunsaturated fatty acids). The Mediterranean diet is, in
fact, characterized by a high amount of vegetables, fruits
and whole grain products, which represent a good source
of fiber, complex carbohydrates, proteins, potassium,
antioxidant substances, and vitamins. Finally, the mode-
rate consumption of red wine associated with the food is
prevalent with respect to other types of alcoholic
beverages.
The association between these nutrients and foods and
the occurrence of cardiovascular diseases has been
largely demonstrated in the last decades (World Health
Organization, 2005; Sofi et al., 2008). However, the fail-
ure of several recent clinical trials supplementing single

nutrients, suggested that the global Mediterranean
nutrition pattern, rather than specific nutrients, might have
protective effects on cardiovascular diseases. This is in
agreement with some intervention studies, main ones
being the Lyon Diet Heart Study and the Dietary
Approaches to Stop Hypertension trial, which indicated
that interventions to change dietary patterns into a
Mediterranean-like pattern could be highly effective in
reducing cardiovascular risk (de Lorgeril et al., 1999;
Sacks et al., 2001).
The Lyon Heart Study conducted among those with
existing heart disease, found a Mediterranean-type diet
high in omega-3 fatty acids reduced recurrent infarction
by 70%, compared with an American Heart Association
diet (de Lorgeril et al., 1999). More recently, an interven-
tion study led by Shai et al. (2008) and published in the
New England Journal of Medicine, reported a benefit for
Mediterranean diet on reducing cardiovascular risk profile
of a population of obese. The authors considered a
comparison of three diet regimens with regard to the
body weight of more than 200 obese subjects: a typical
low-calorie diet low in fat, a Mediterranean-type diet, and
a low-calorie and low-carbohydrate diet without caloric
restriction. After approximately two years of follow-up, the
low-carbohydrate diets were more effective in obtaining
weight loss in the short-term, but the long-term benefits
obtained in addition to the weight loss, which included
improvement of the metabolic parameters were obtained
in the subgroup of people following the Mediterranean
diet (Shai et al., 2008).
However, the intervention diets in those trials were very
different from common dietary patterns in Western
populations. People choose foods and combinations of
foods rather than isolated nutrients, and practical dietary
advice to the public in terms of foods is preferred. Dietary
changes may be more readily achieved if recommended
foods are compatible with existing patterns of food
consumption. Until recently, research efforts to identify
dietary means of reducing disease risk have focused on
single-nutrient interventions to affect responses in single
medical conditions. Determining appropriate dietary
recommendations for improved health is further compli-
cated by the paucity of information of the clinical value
and feasibility of the interactive effects of multiple
nutrients consumed in combination. Recognizing that
nutrients are not ingested in isolation, but rather as
interactive constituents of a complete diet, much of the
focus in nutrition and cardiovascular research in recent
years has shifted from assessment of single-nutrient
effects on medical conditions associated with increased
risk to that of the effects of the total diet or dietary
pattern. Therefore, research efforts in this field switched
progressively to the evaluation of a score for the
adherence to the Mediterranean dietary pattern, rather
than to the identification of single nutrients in association
Sofi et al. 57
with the disease.
The most important attempt to define the degree of
adherence to the Mediterranean diet has been released
by Trichopoulou et al. (2003) on the frame of the
European Prospective Investigation into Cancer and
Nutrition (EPIC) study. The authors established a score
of adherence that takes into account the main dietary
variables, divided into food groups, typical of the
Mediterranean diet. This adherence score, based on food
groups typically present in the Mediterranean diet (bread,
pasta, fruit, vegetables, fish, legumes, moderate red wine
consumption, and olive oil), gives a positive score to
people who consume more than the median of the overall
population for foods typical of the Mediterranean diet, and
a negative score to those who consume a higher amount
of foods which are not typical of the Mediterranean diet.
Hence, a score of 0 represents the lowest adherence to
the Mediterranean diet, while a score of 9 represents the
highest adherence to the Mediterranean diet.
In recent meta-analyses, we have demonstrated that a
greater adherence to the Mediterranean diet, estimated
through a computational score, was associated with a
reduced incidence of overall mortality (-8%), as well as of
cardiovascular mortality and/or incidence (-10%) (Sofi et
al., 2010, 2008).
DIET AND NEOPLASTIC DISEASES
Cancer is a major cause of mortality throughout the
world, and in the developed world, it is generally
exceeded only by cardiovascular diseases (World Health
Organization Study Group, 2003; World Health
Organization, 2005; World Health Organization, 2006).
An estimated 10 million new cases and over 6 million
deaths from cancer occurred in 2000. As developing
countries become urbanized, patterns of cancer,
including those most strongly associated with diet, tend to
shift towards those of economically developed countries.
Between 2000 and 2020, the total number of cases of
cancer in the developing world is predicted to increase by
73%, and in the developed world, to increase by 29%,
largely as a result of an increase in the number of old
people.
Dietary factors are estimated to account for appro-
ximately 30% of cancers in industrialized countries,
making diet second only to tobacco as a theoretically
preventable cause of cancer (Key et al., 2004). This
proportion is thought to be about 20% in developing
countries, but may grow with dietary change. Many of the
prominent hypotheses for effects of diet on cancer risk
are derived from examination of the associations
between dietary patterns and cancer rates in different
populations around the world. It was noted in the 1970s
that developed Western countries have diets high in
58 Int. J. Med. Med. Sci.
animal products, fat and sugar, and high rates of cancers
of the colorectum, breast and prostate developing
countries typically have diets based on one or two
starchy staple foods, low intakes of animal products, fat
and sugar, low rates of these ‘Western’ cancers, and
sometimes high rates of other types of cancer such as
cancers of the esophagus, stomach and liver. Other
studies have shown that cancer rates often change in
populations that migrate from one country to another, and
change over time within countries.
During the last 30 years, hundreds of studies that
examined the association between diets of individuals
and their risk for developing cancer have been published.
Some studies have investigated the possible role of
Mediterranean diet and the occurrence of neoplastic
diseases showing a beneficial effect of such dietary
pattern in the general population. The results of recent
meta-analyses published by our group clearly showed
that a strict adherence to the rules of the classical
Mediterranean diet determines a 6% reduced risk of
incidence and/or mortality from neoplastic diseases (Sofi
et al., 2008, 2010).
DIET AND NEURODEGENERATIVE DISEASES
An interest association between diet and disease states
is the one related to the reduced risk of incidence of
neurodegenerative diseases such as Alzheimer’s and
Parkinson’s disease that has been observed in some
recent studies (Sofi et al., 2008). Indeed, several
observations hypothesised a potentially important role for
diet in the prevention and occurrence of Alzheimer’s
disease.
The links proposed between dietary factors and
neurocognitive diseases are different. Neurodegenerative
diseases are characterized in their prevalent forms, by an
increased oxidative stress and inflammation (Rinaldi et
al., 2003). To date, oxidative stress and inflammation can
be modulated and influenced by many dietary com-
pounds, hence supporting the hypothesis that nutritional
habits may play a role on the pathogenesis of
Alzheimer’s disease. Moreover, another possible link
between diet and such diseases are that related to the
presence of high levels of homocysteine, an intermediate
compound of the metabolic cycle of methionine in
patients affected by cognitive impairment (Seshadri and
Wolf, 2003). Finally, additional interesting links between
diet and neurocognitive disorders are those related to
dietary fats, alcohol and inflammatory parameters
(Mukamal et al., 2003; Wärnberg et al., 2009). High
intake of cholesterol has been shown to increase the
deposition of beta-amyloid in animal brains and high
intake of fats may also determine oxidative stress. In
addition, some findings in animal models demonstrated
that alcohol is a neurotoxin, so acting as a modulator of
the oxidative brain damage.
In the last few years, researches on diet and nutrition in
relation to the occurrence of neurodegenerative diseases
have been reported with interesting findings on
Alzheimer’s and Parkinson’s diseases (Sofi et al., 2008).
In fact, a greater adherence to a Mediterranean-type diet
has been shown to decrease the risk of occurrence of
both Parkinson’s and Alzheimer’s disease. The results of
our meta-analyses showed that an increase of 2 points in
the adherence score to Mediterranean diet is associated
with a reduction of over than 10% of the risk of
occurrence of such pathologies, by demonstrating the
beneficial role of diet and dietary habits in the prevention
of neurocognitive disorders (Sofi et al., 2008, 2010).
CONCLUSION
There is a vast amount of literature, to date, that reports a
healthy dietary habit to be one of the strongest preventive
measure for the general population, as well as for the
population of patients with a manifested disease. Diet is
able to decrease the risk of mortality and reduce the
incidence of some of the most important disease states.
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